Methods for Estimating the Due Date - ACOG
I am mostly concerned with the accuracy because i want to be able to First trimester dating ultrasounds are the gold standard for EDD's. You should always use the result of a scan that is done earlier on in pregnancy for 'dating' purposes as it will be more accurate. In the later part of pregnancy the . ultrasound biometry. Outcomes: To determine whether ultrasound dating provides more accurate gestational age assessment than menstrual dating with.
Mean sac diameter measurements are not recommended for estimating the due date. Dating changes for smaller discrepancies are appropriate based on how early in the first trimester the ultrasound examination was performed and clinical assessment of the reliability of the LMP date Table 1. For example, for a day-5 embryo, the EDD would be days from the embryo replacement date. Likewise, the EDD for a day-3 embryo would be days from the embryo replacement date.
Clinical Considerations in the Second Trimester Using a single ultrasound examination in the second trimester to assist in determining the gestational age enables simultaneous fetal anatomic evaluation. With rare exception, if a first-trimester ultrasound examination was performed, especially one consistent with LMP dating, gestational age should not be adjusted based on a second-trimester ultrasound examination.
Ultrasonography dating in the second trimester typically is based on regression formulas that incorporate variables such as the biparietal diameter and head circumference measured in transverse section of the head at the level of the thalami and cavum septi pellucidi; the cerebellar hemispheres should not be visible in this scanning plane the femur length measured with full length of the bone perpendicular to the ultrasound beam, excluding the distal femoral epiphysis the abdominal circumference measured in symmetrical, transverse round section at the skin line, with visualization of the vertebrae and in a plane with visualization of the stomach, umbilical vein, and portal sinus 8 Other biometric variables, such as additional long bones and the transverse cerebellar diameter, also can play a role.
Date changes for smaller discrepancies 10—14 days are appropriate based on how early in this second-trimester range the ultrasound examination was performed and on clinician assessment of LMP reliability. Because of the risk of redating a small fetus that may be growth restricted, management decisions based on third-trimester ultrasonography alone are especially problematic; therefore, decisions need to be guided by careful consideration of the entire clinical picture and may require close surveillance, including repeat ultrasonography, to ensure appropriate interval growth.
The best available data support adjusting the EDD of a pregnancy if the first ultrasonography in the pregnancy is performed in the third trimester and suggests a discrepancy in gestational dating of more than 21 days.
Conclusion Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. As soon as data from the LMP, the first accurate ultrasound examination, or both are obtained, the gestational age and the EDD should be determined, discussed with the patient, and documented clearly in the medical record.
The American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal—Fetal Medicine recognize the advantages of a single dating paradigm being used within and between institutions that provide obstetric care.
Table 1 provides guidelines for estimating the due date based on ultrasonography and the LMP in pregnancy, and provides single-point cutoffs and ranges based on available evidence and expert opinion.
Fetal Imaging Workshop Invited Participants. A comparison of recalled date of last menstrual period with prospectively recorded dates. J Womens Health Larchmt ; Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.
Am J Obstet Gynecol ; Last menstrual period versus ultrasound for pregnancy dating. Int J Gynaecol Obstet ; First trimester ultrasound screening is effective in reducing postterm labor induction rates: Ultrasound for fetal assessment in early pregnancy.
Cochrane Database of Systematic ReviewsIssue 7. It will need a size lag of up to weeks before one would start to consider malformations such as microcephaly small head syndrome. I had a scan at 8 weeks and my doctor said the fetus is only 7 weeks, and it was because I had irregular menstrual cycles.
I had another scan at 34 weeks and my doctor now said the fetus size was only 31 weeks. Should I stick to the earlier scan or should I use the later scan to fix my Due date? If my fetus is smaller, would it be wise to leave it in the womb for as long as possible so that it can grow bigger and get more mature?
You should always use the result of a scan that is done earlier on in pregnancy for 'dating' purposes as it will be more accurate. In the later part of pregnancy the measurements will be affected by growth variations and will no longer reflect the fetal 'age' correctly. In your case, the findings apparently indicated that you have a smaller than average baby.
It is incorrect logic to think that babies who are not growing well should be left inside the womb for a longer period of time. In fact the reverse should be true.
The baby may be better off outside than in and for this reason we sometimes have to deliver these babies well before the actual due date. I had a scan at 34 weeks. My doctor said the estimated weight of the fetus is 2.
Is this too small? How much should an average baby weigh at 34 weeks? The weight for an average size fetus at 34 weeks is about 2. We would say a baby is small-for-dates when it's weight is below the 10th percentile line, and in the case of 34 weeks this will be 1. Please take a look at the Intrauterine weight chart. Your baby is on the small side, but not too small. You must also know that estimating the weight of the fetus with ultrasound measurements sometimes can incur errors of over 10 percent.
Your doctor will usually make an assessment together with other ultrasound findings. I will have a scan tomorrow. What is the chance that I would be able to see the sex of my baby on the screen? I really do not want to know this before the baby is born.
The chance that you will recognize the genital organs of the baby without any prompting is very small.
Predicting delivery date by ultrasound and last menstrual period in early gestation.
Interpretating an ultrasound image requires a lot of training and skill and is not like looking at a photograph of a person taken in front of him. Patients are often unable to 'see' the parts of the fetus the doctor is actually carefully studying during a scanning session. A friend of mine was seen at the ER because of pain. She was pregnant for about 7 weeks. They did a scan and found no sac in the uterus and asked her to go home.
Two days later she was admitted again to another hospital with massive bleeding from an ectopic pregnancy. Why was this initially missed on the scan?
Predicting delivery date by ultrasound and last menstrual period in early gestation.
Ectopic pregnancyis notorious for not being diagnosed early, as the physician has always to exclude basically 3 other conditions in early pregnancy which give rise to pain. She can have pain for no apparent pathology in early pregnancy, probably as a result of of uterine and venous engorgement. Missed or inevitable abortion. Ruptured ovarian cyst or pain arising from other abdominal organs. Ultrasound, unfortunately, will not be able to make a 'definitive' diagnosis of ectopic pregnancy in most of the cases as it is often not possible to visualize the actual gestational sac in the fallopian tubes.
The fact that there is no gestational sac seen in the uterine cavity may just mean that the pregnancy has not been growing normally or that some sort of an abortion might have occured or that the pregnancy, due to to an irregular menstrual cycle in the woman, is much less advance than is thought. The doctor often needs to take into account of the menstrual history, the time she had a positive pregnancy test, the intensity of the pain, physical signs, a blood count and findings on ultrasound scan.
I would appreciate any information on molar pregnancy that you can provide. Last year I had emergancy surgery done because of this condition. It has an average annual temperature of The state covers a land area of approximately 8, The Enugu State University Teaching Hospital, Parklane, is a state-owned teaching hospital located in the center of the Enugu metropolis.
Both centers provide antenatal and postnatal care services to pregnant women in Enugu State. The commonest indication for induction of labor in the two hospitals and in our environment is prolonged pregnancy. Every singleton pregnant woman due for a routine delivery planning discussion at a gestational age of 36 weeks and beyond was eligible for the study.
Exclusion criteria included uncertainty of date, presence of contraindications to vaginal delivery, irregular menstrual cycle prepregnancy, use of hormonal contraceptives prior to pregnancy, or bleeding during pregnancy. After individual counseling of eligible participants, pretested structured questionnaires were administered to consecutive consenting women by trained medical interns.
Ethical clearance for the study was obtained from the institutional review board of the University of Nigeria Teaching Hospital, Enugu. Data collected included the sociodemographic characteristics of the respondents age, marital status, tribe, level of education, occupation, parityopinions and preferences regarding LMP and ultrasound scan dates, and their attitudes toward postdatism and induction of labor in relation to estimated dates.
The primary outcome measure was willingness to accept induction of labor at an LMP-derived gestational age of 40 weeks plus 10 days when late pregnancy ultrasound scan-derived gestational age was less than 40 weeks plus 10 days.
The first trimester was defined as a gestational age of 1—13 weeks, the second trimester as 14—27 weeks, and the third trimester as 28—42 weeks.